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Title: Mother to child transmission of HIV : maternal and child characteristics.
Author: Luo, Chewe Angela.
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2000
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A prospective study at the University Teaching Hospital of 306 women with their infants, who were enrolled at delivery, was conducted in 1997. The primary aim was to define the magnitude and effects of maternal human immuno-deficiency virus (HIV) infection on obstetric problems and infant outcome. Women were mainly over 19 years (87.3%), literate (73.7%) and married (91.4%), with no formal income (75.7%). 48.2% and 46.7% had antenatal or post-partum anaemia (PPA) and of these 1.8% and 6.2% were severely anaemic. Low post-partum (PP) serum retinol «0.7f.lmoI/L) and CD4 counts «400 cells/mm3 ) occurred in 12.8% and 16.2% of the women. The commonest obstetric problems were previous child death (32.4%), malaria treatment during pregnancy (32.6%), previous abortion (16.4%) and hypertension (13.7%). Post-partum, 30.1% of the women were HIV infected, 14.9% rapid plasma reagin (RPR) positive and 4.5% hepatitis B surface antigen (HBsAg) positive. Factors independently associated with HIV infection were: alcohol intake during pregnancy (RR 5.67); ante-partum haemorrhage (RR 5.85); PP HBsAg positivity (RR 27.45); low PP CD4 cell count (RR 10.63) and PPA (RR 3.99). Primigravidae had a lower risk ofHIV infection (RR OJ). For PPA independent risk factors were: caesarean section (RR 9.95); HIV infection (RR 2.81) and low PP mean corpuscular haemoglobin concentration (MCHC) (RR 8.33); mean corpuscular volume (MCV) (RR 2.39) and serum retinol (RR 3.03). Alcohol intake during pregnancy (RR 0.22) and low PP maternal weight (RR 0.10) were associated with reduced risk ofPPA. The prevalence of low birth weight (LBW; weight <2.5kg), pre-term delivery «37 weeks gestation) and intra-uterine growth retardation (IUGR; weight < lOth centile for gestational age) were 18.9%, 23.8% and 25.9%. These showed no association with maternal HIV infection although the mean birth weight was significantly lower in children born of HIV infected mothers (P=0.006). In HN non-infected women, antenatal anaemia was independently associated with increased risk pre-term delivery (RR 5.l2) and low birth weight (RR 5.08). Low PP serum retinol increased the risk of IUGR (RR 3.10). In HN infected women, lack of paternal income was associated with pre-term delivery (RR 11.7), IUGR with LBW (RR 3.59) and antibiotic treatment in pregnancy with IUGR (RR 5.85). The cumulative rate of HN mother to child transmission (MTCT) at 1 year of age was 31 %, with 10.3%, 1O.l% and 9.l% of infants DNA polymerase chain reaction (PCR) positive at birth, 1 month and 4 to 12 months respectively. On multivariate analysis, PP maternal viral load (>50,OOOcopies Iml) was the only risk factor associated with early infant HN acquisition (birth and 1 month) (P = 0.005) and cumulative infections at one year (P=O.OOI). At a year of age, HIV infected children were severely undernourished (weight for age median Z-score -3.46) and stunted (height for age median Z-score -4.44). Stunting was the main form of malnutrition in uninfected infants regardless of maternal HN status. Reported morbidity in infancy was unaffected by HN status. The infant mortality rate was 136 per 1000 live births, 85 per 1000 in HN uninfected children of uninfected mothers, 272 per 1000 in infants of infected mothers and 424 per 1000 in infected infants. After correcting for confounders, maternal HN infection (HR 0.28) and primigravidae (HR 0.20) were significant risk factors for infant survival. The population attributable risk percentage of infant mortality was 41.3% for maternal HN infection and 24.9% when the infant was HN infected as well.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: AIDS; Africa Medicine